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Sex Research and
Sex Therapy
A Sociological Analysis of
Masters and Johnson
Ross Morrow
New York London
RT06528_C000.indd v 8/29/2007 7:24:42 PM
Routledge Routledge
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© 2008 by Ross Morrow
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Library of Congress Cataloging-in-Publication Data
Morrow, Ross, 1962-
Sex research and sex therapy : a sociological analysis of Masters and Johnson / Ross
Morrow.
p. ; cm. -- (Routledge advances in sociology ; 32)
Includes bibliographical references and index.
ISBN 978-0-415-40652-9 (hardback : alk. paper)
1. Masters, William H. Human sexual response. 2. Masters, William H. Human
sexual inadequacy. 3. Johnson, Virginia E. 4. Sex (Biology)--Research--United
States--History--20th century. 5. Sex therapy--Research--United
States--History--20th century. 6. Sexology--Research--United States--History--20th
century. 7. Sex (Biology)--Social aspects--United States. 8. Sex therapy--Social
aspects--United States. 9. Sexology--Social aspects--United States. I. Title. II. Series.
[DNLM: 1. Masters, William H. Human sexual response. 2. Masters, William H.
Human sexual inadequacy. 3. Johnson, Virginia E. 4. Sexology. 5. Research Design.
6. Sexual Behavior. 7. Sexual Dysfunction, Physiological. 8. Sexual Dysfunctions,
Psychological. HQ 21 M883s 2007]
QP251.M67 2007
612.6072--dc22 2007009902
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Contents
Acknowledgments ix
1 Introduction 1
2 The Sociology of Sex in Historical Perspective 7
3 Theoretical Perspectives on Sexuality 49
4 Masters and Johnson’s Research on Human Sexual Response 75
5 A Critique of Masters and Johnson’s Model of the Human
Sexual Response Cycle 97
6 A Critique of Masters and Johnson’s Concept and Classification
of Sexual Dysfunction 115
7 A Critique of Masters and Johnson’s Sex Therapy Program 143
8 Conclusion 175
References 181
Index 197
vii
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RT06528_C000a.indd viii 9/6/2007 10:03:00 AM
Acknowledgments
Most of the research for this book occurred while I was working at the
University of Newcastle, New South Wales. This was during a time of sub-
stantial decline in relative public funding of Australian universities despite
healthy federal budget surpluses. This decline of funding was compounded
by the well-publicised fi nancial difficulties of the university itself. The
declining funds and the resulting squeeze on academic labour, not sur-
prisingly, led to many adverse consequences, including the loss of time for
research, reflection and writing. This undoubtedly delayed the research for
this book which was not completed until I left the university in 2005. Given
the difficult gestation of the research, I am particularly grateful to those
people who kindly helped and supported me during this time.
Rachel Sharp has been a wonderful mentor, friend and supporter who
believed in this project all the way through and who kindly gave me assis-
tance whenever I needed it. She was particularly helpful with some of the
more difficult issues that came up. Mervyn Hartwig and Caroline New
both made helpful comments on an earlier version of the manuscript. They,
along with Rachel, have been most supportive colleagues and friends.
Together, they also exposed me to an engaging and stimulating intellectual
milieu outside my university environment. This has enlivened my inter-
ests and imagination, deepened my knowledge and sharpened my critical
skills.
My friend and colleague Peter Khoury has been an unfailing source of
support, encouragement, good ideas and sagely advice. He also read and
gave valuable feedback on key parts of the manuscript. Without his kind
assistance this book would not have been produced and I owe him more
than I can say here. Robert Irvine generously and frequently passed on
references and research material he came across while trawling through the
research literature. He was a supportive friend and colleague and a criti-
cal interlocutor with me about many issues. Karen McLeod gave patient,
cheerful and invaluable assistance in typing, formatting and revising the
original manuscript.
ix
RT06528_C000a.indd ix 9/6/2007 10:03:00 AM
x Acknowledgments
My late friend and colleague Dennis McIntyre was an enthusiastic sup-
porter of my work. He was a true friend over many years and through
difficult and challenging times. He is greatly missed and I am very sad that
he did not live to see this work completed. I would especially like to thank
my parents—John and Marion Morrow—for their generous and continu-
ing support, help and encouragement over many decades. Their very kind
assistance has been crucial to me fi nishing the research and preparing it for
publication. I would also like to thank Revue Sexologique/The Sexologi-
cal Review for kind permission to include material in chapters five and six
from a previously published article ‘A critique of Masters’ and Johnson’s
concept and classification of sexual dysfunction’. This was originally pub-
lished in Revue Sexologique/Sexological Review (1996) vol. 4, no. 2, pages
159–180. Finally, I would like to thank Routledge for believing in this work
and for backing it. Without their invaluable support and input this mono-
graph might never have been produced. Needless to say, I take responsibil-
ity for the final contents.
RM
ABOUT THE AUTHOR
Ross Morrow has a PhD in sociology and has published nationally and
internationally in the fields of sociology, social theory and human sexu-
ality. He currently teaches social theory at the University of Sydney and
social science at the University of Technology, Sydney.
RT06528_C000a.indd x 9/6/2007 10:03:01 AM
1 Introduction
This book is intended as a contribution to the sociology of sex. It is primar-
ily concerned with William Masters and Virginia Johnson’s (1966; 1970)
scientific sex research and its clinical applications within the field of sex
therapy. Masters (1915–2001) was a U.S. obstetrician and gynecologist,
and Johnson (1925–) was his research assistant and later co-researcher.
Together, they were two of the most significant and influential sexolo-
gists of the twentieth century (Dein 1993/1994; Strong 1993). They are
generally regarded as the most important researchers to have scientifically
studied human sexual functioning and they are widely acclaimed as the
founders of sex therapy in the latter half of the twentieth century. They
are internationally renowned, their books have been best sellers, and they
have been honoured with more than a dozen awards each from professional
groups for their contributions to the scientific study of sex. Their scientific
work was also an important exemplar of ‘essentialism’, in a particularly
strong form. Essentialism is the most dominant and influential paradigm in
sex research (Masters, Johnson and Kolodny 1985; Weeks 1985; Bullough
1994d; Harding 1998, 12).
The major aim of this book is to provide a sociological analysis and cri-
tique of the conceptual foundations and practice of Masters and Johnson’s
(1966; 1970) sex research and therapy, as articulated in their ‘seminal’ texts
Human Sexual Response and Human Sexual Inadequacy. The kind of cri-
tique offered here is primarily an ‘internal’ critique of the main themes and
ideas in these books. However, I also explore some of the wider theoretical,
conceptual and historical issues pertaining to the sociology of sex. These
include a discussion of the major theoretical perspectives on human sexual-
ity, and a recuperation of the forgotten history of the sociology of sex. A
key theme in my overall argument is that Masters and Johnson constructed
their apparently scientific ideas about sexual function and dysfunction with
reference to dominant Western beliefs and values about sexuality, and that
their sex therapy program operated as an institution of social control.
The book does not attempt to make a comprehensive sociological study
of all Masters and Johnson’s work. Nor does it claim to offer a ‘sociol-
ogy of knowledge’ of their work. Apart from an internal critique of their
RT06528_C001.indd 1 7/27/2007 3:03:12 PM
2 Sex Research and Sex Therapy
project, such research would arguably need to address a range of other
pertinent issues, including a sociological account of sex therapy as a pro-
fession; the history, organisation and internal workings of Masters and
Johnson’s research institute; a study of the social processes and practices
through which they produced and disseminated their ‘knowledge’; an
examination of their workshops, training sessions, media exposure and
annual conferences; an analysis of their entire corpus of published and
unpublished works, including their more popular writings; their profes-
sional relationships with other sexologists; and their personal relationships
with each other, including their marriage, divorce and retirement, and
Masters’ illness and eventual death from Parkinson’s disease. This kind of
wider study might also usefully examine the relationship between the sex
therapy industry initiated by Masters and Johnson in 1970, and the wider
therapeutic, medical and individualising culture of the United States which
has been analysed in the work of authors such as Sennett (1977), Lasch
(1980), Zilbergeld (1983), Hewitt (1998) and Conrad (2005).
I have primarily focused my attention on the study and analysis of
Human Sexual Response and Human Sexual Inadequacy for three main
reasons. Firstly, these two books are probably Masters and Johnson’s most
original, robust, famous and influential works. Human Sexual Response
reported on a sex research project which aimed, for the fi rst time, to pro-
duce defi nitive scientific information about human sexual physiology. It
involved the largest ever direct laboratory study of human sexual response
in 694 men and women over an eleven-year period from 1954 to 1965. In
reporting the ‘defi nitive’ fi ndings of their research, Masters and Johnson
(1966) argued that the sexual responses of males and females are so similar
that they can be understood as occurring within a single four stage human
sexual response cycle. The model of this cycle formed the centrepiece of
their book.
With the publication of Human Sexual Response, Masters and Johnson
became world famous almost overnight. Their research attracted interna-
tional media attention and their book became a best seller (Brecher 1970,
28; Belliveau and Richter 1971, 59). Their research fi ndings were largely
accepted as scientific fact even though some critics disapproved of their
research methods (Belliveau and Richter 1971, 64; Gagnon 1975, 137).
Medical schools across the United States began using Masters and John-
son’s text to teach new courses on human sexual response and their model
of the human sexual response cycle was incorporated (with some amend-
ments) into the American Psychiatric Association’s (1980) Diagnostic and
Statistical Manual of Mental Disorders (DSM-III). It was used as a model
of normal human sexual functioning (‘Playboy Interview: Masters and
Johnson’ 1976, 131, 162; American Psychiatric Association 1980).
Human Sexual Inadequacy achieved its fame and influence for a num-
ber of different reasons. Firstly, it provided what was probably the fi rst new
system for classifying sexual dysfunctions since the Middle Ages (Boyle
RT06528_C001.indd 2 7/27/2007 3:03:14 PM
Introduction 3
1994, 108). It became the prototype for the sexological diagnosis of sex-
ual dysfunctions after 1970, and its categories of sexual dysfunction were
incorporated into the DSM-III (1980) as official mental disorders (Irvine
1990a, 192-3). Furthermore, Masters and Johnson themselves continued to
rely heavily on this system of classification for many years after it was fi rst
formulated (Masters et al 1985; 1994). Secondly, Human Sexual Inade-
quacy contained ‘new’ ideas about the aetiology of sexual dysfunctions. In
contrast to the previously dominant psychoanalytic view that sexual dys-
functions were caused by deep unconscious confl icts, Masters and Johnson
(1970) put forward the view that sexual dysfunctions were predominantly
caused by fear of sexual inadequacy, and excessive self-monitoring (the
adoption of a ‘spectator role’) during sexual activity. Thirdly, Masters and
Johnson introduced a ‘new’ approach to the treatment of sexual dysfunc-
tions. This involved a rapid, intensive, treatment program, treatment of
couples by male and female cotherapists (such as a doctor and psychologist),
and the integration of specific therapeutic strategies into an overall treat-
ment package. Fourthly, Masters and Johnson provided an unprecedented
report on the effectiveness of their sex therapy program. They reported the
results of treating 790 patients for sexual dysfunctions over an eleven year
period from January 1959 to December 1969. This is still the largest study
of treatment outcomes for sexual dysfunction which has ever been reported
(Heiman and Meston 1997, 149). In addition, the study provided follow-
up data on patients five years after they had fi rst been treated in order to
indicate how many had reverted to a sexually dysfunctional state. Masters
and Johnson reported that their new sex therapy program was highly suc-
cessful with an overall failure rate of only 20%. This failure rate seemed
incredibly low in comparison to psychoanalysis which was the main form
of treatment for sexual dysfunctions prior to Masters and Johnson.
The publication of Human Sexual Inadequacy was greeted with wide-
spread celebration, acclaim and optimism that sexual dysfunctions ‘could
be substantially eliminated’ before the end of the decade (Zilbergeld and
Evans 1980, 30). There was very little critical analysis of Masters and John-
son’s (1970) claims (Zilbergeld and Evans 1980). Their book, and the work
on which it reported, made a major contribution to the development of sex
therapy as a new type of specialist occupation. An estimated 5,000 sex
therapy clinics developed across the United States in the wake of publica-
tion of Human Sexual Inadequacy, and sex therapists soon developed their
own certifying organisations and professional journals (Heidenry 1997,
172; Zilbergeld and Evans 1980, 30). Sex therapy has developed, and been
modified, since the publication of Human Sexual Inadequacy, but Masters
and Johnson’s treatment approach still forms the basis of most sex therapy
programs (Bancroft 1986, 172; Davison and Neale 1994, 379; Wiederman
1998, 89; Everaerd 2001; Goren 2003, 495).
The second reason for primarily focusing my attention on Human Sexual
Response and Human Sexual Inadequacy is that these two books, and the
RT06528_C001.indd 3 7/27/2007 3:03:15 PM
4 Sex Research and Sex Therapy
projects they describe, cannot be adequately understood in isolation from
each other. These two books provide accounts of two integral and inter-
related components of what is almost a single overarching research and
clinical program. This program sought to describe and understand normal
human sexual response partly in order to help understand the causes, types
and treatment of sexual dysfunctions. The research and clinical programs
discussed in these books were not only closely connected by their rationales.
They also substantially overlapped and ran in parallel. For example, Mas-
ters and Johnson’s research on sexual physiology ran from 1954 to 1965
while their clinical program for the treatment of sexual dysfunction ran
from 1959 to 1970. The fi ndings of these two programs also had reciprocal
influences on each other. For example, Masters and Johnson’s model of the
human sexual response cycle was later used as a norm of healthy sexual
functioning in their clinical treatment program. Similarly, when research
participants had problems with their sexual performances during the labo-
ratory research, Masters and Johnson drew on their clinical experiences to
assist these participants to develop more ‘successful’ sexual responses.
Thirdly, it is quite surprising that, despite the apparently momentous
scientific, therapeutic and cultural significance of Masters and Johnson’s
(1966; 1970) work, there has been a marked lack of critical attention to it,
including by sociologists. To my knowledge, no large scale systematic soci-
ological study of this work has previously been undertaken, completed or
published. Nor has there been any extended and detailed sociological anal-
ysis of the main arguments and ideas put forth in Human Sexual Response
and Human Sexual Inadequacy. The small number of books which are
concerned with Masters and Johnson’s (1966; 1970) research and therapy
are primarily non-sociological, and expository, serving mainly to introduce
and explain this work to a general audience (see, for example, the books
by Brecher and Brecher 1968; Belliveau and Richter 1971; and Lehrman
1976). As discussed in chapter 2, there is a small sociological literature
on Masters and Johnson’s laboratory research and therapy program. This
mainly consists of book chapters and journal articles (and even sections of
chapters and articles) most of which are not primarily concerned with Mas-
ters and Johnson. This literature is also relatively fragmented, and focused
on selective and partial aspects of their work. In addition, this literature
has often been non-cumulative. Researchers have been unable to build on
previous studies because they have not been aware of them. Consequently,
one of the main aims of this study is to combine original analysis of Mas-
ters and Johnson’s (1966; 1970) work, with the fi ndings of the existing
literature, in order to develop a more systematic account and evaluation of
their project.
My research approach relies on a broadly ‘social constructionist’ theo-
retical perspective. It is primarily used to analyse the rationale, process and
outcomes of Masters and Johnson’s research and therapy programs in rela-
tion to various social factors which affected their work. In particular, this
RT06528_C001.indd 4 7/27/2007 3:03:15 PM
Introduction 5
approach is used to analyse and criticise Masters and Johnson’s unsubstan-
tiated and strongly essentialist assumptions about human sexuality, the
supposed objectivity of their research findings, their empiricism, and the
apparent value neutrality of their scientific research. This social construc-
tionist framework, however, is necessarily grounded in explicitly realist
philosophical assumptions in order to preserve the possibility of objective
knowledge while avoiding the problem of relativism.
The study itself is based on documentary research, analysis and eval-
uation of both primary and secondary sources. It involved a systematic
analysis and evaluation of Masters and Johnson’s (1966; 1970) major texts,
Human Sexual Response and Human Sexual Inadequacy. It also involved
the study of a number of other works by Masters and Johnson which
helped to shed light on aspects of their sex research or sex therapy program
(e.g., Masters and Johnson 1976; Masters and Johnson 1979; Masters and
Johnson 1980; Masters, Johnson and Kolodny 1985; and Masters, Johnson
and Kolodny 1994). Research was also conducted by drawing on other
primary sources which were relevant to the study of Masters and Johnson,
as well as the secondary literature on their work in the areas of education,
feminism, history, medicine, philosophy, psychiatry, psychology, sexology,
sex therapy and sociology. A significant proportion of the documentary
research in this study took the form of historical research using published
sources of information to reconstruct some of the unknown history of the
sociology of sex.
The book consists of eight chapters, including this introduction. Chapter
2 is partly concerned with accounting for the nature and dearth of previ-
ous sociological attention to Masters and Johnson’s (1966; 1970) work. In
addressing this issue, it challenges the ‘conventional’ view of the history of
the sociology of sex, and argues for a new interpretation of that history.
Chapter 3 reviews and evaluates two of the major theoretical perspec-
tives on human sexuality: essentialism and social constructionism. While
the chapter is critical of aspects of both perspectives, and their application
to the study and understanding of human sexuality, it argues for the use
of a social constructionist perspective, grounded in realist philosophy, in
this book.
Chapter 4 is concerned with Masters and Johnson’s (1966) laboratory
research on human sexual response. It reviews and analyses the rationale,
conduct, major fi ndings and public impact of this research. It argues, in
part, that there was a generally favourable response to Masters and John-
son’s research and that, when it was criticised, the criticism was more con-
cerned with the methods rather than the fi ndings of their research.
Chapter 5 provides a critique of the centrepiece of Masters and John-
son’s (1966) research on sexual physiology: their four stage model of the
human sexual response cycle. The chapter criticises their claims about the
originality of their model, the strongly essentialist assumptions on which
it is based, inconsistencies between their model and their reported data on
RT06528_C001.indd 5 7/27/2007 3:03:15 PM
6 Sex Research and Sex Therapy
sexual response, their ideological emphasis on the sexual similarities of
males and females, and their inaccurate research findings.
Chapter 6 provides a critique of Masters and Johnson’s (1970) con-
cept and classification (or nosology) of sexual dysfunction. It criticises the
nosology for its reliance on a model of healthy sexual functioning which
has limited generalisability as a set of clinical norms; its gender biases in
the classification of sexual dysfunctions; its hetero-coital bias; its inability
to deal with possible problems concerning sexual desire; its medicalisation
of deviant sexual response; and its tendency to conflate sexual dysfunctions
with sexual problems.
Chapter 7 critically discusses the principles, practices and effectiveness
of Masters and Johnson’s (1970) sex therapy program. It argues, in part,
that much of this program was based on the unacknowledged principles
and techniques of behaviour therapy, that the effectiveness of their treat-
ment program could not be ascertained from their published study of it,
and that the program itself tended to implicitly operate as an institution of
social control.
Finally, chapter 8 concludes the book by summing up the main argu-
ment, and briefly noting some of the implications for contemporary sex
therapy.
RT06528_C001.indd 6 7/27/2007 3:03:15 PM
2 The Sociology of Sex in
Historical Perspective
INTRODUCTION
The research for this chapter developed from an attempt to explain the
relative lack of sociological attention to Masters and Johnson’s (1966;
1970) work in the forty odd years since they first published Human Sexual
Response. After reviewing the small sociological literature about them, and
reading conventional accounts of the history of the sociology of sex, the
explanation as to why sociologists had largely ignored Masters and John-
son initially seemed clear. Sociology, for most of its history, had apparently
ignored the study of sexuality altogether, and this naturally included the
work of Masters and Johnson. Furthermore, since sociologists claimed that
the sociology of sex fi rst developed in the 1960s or early 1970s, (around the
same time that Masters and Johnson published Human Sexual Response
and Human Sexual Inadequacy), it could also have been argued that the
sociology of sex was too immature to offer any kind of distinctive or critical
analysis of their work. If these views were correct then apparently all that
remained to be done, in terms of this part of my research, was to document
and expound the evidence supporting these propositions.
However, my research on the sociology of sex led me to reject the con-
ventional history of it, and the way it might have accounted for the neglect
of Masters and Johnson’s work. The conventional view is that there was
little or no sociological study of sexuality before World War II, and that a
sociology of sex only emerged in the postwar era, and, in some accounts,
as late as the 1960s or early 1970s. In the conventional view, there are
various ‘explanations’ for this but it is often ‘explained’ by referring to the
way in which sex research was stifled and inhibited by a repressive society.
The apparent emergence of a sociology of sex in the postwar era was also
‘explained’ in terms of the lifting of repression and the greater opportuni-
ties for sociologists to study sexuality.
In this chapter, I criticise the conventional view of the history of the
sociology of sex, and argue that sociology was part of the discursive explo-
sion about sexuality that occurred in Western societies from the eighteenth
century. Much of this chapter is taken up with documenting the largely
RT06528_C002.indd 7 7/27/2007 3:07:55 PM